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1 <br /> DOULOS ENVIRONMENTAL, INC. SAMPLING INFORMATION SHEET <br /> Client _�, j�� � �- Sampling Date <br /> Site /�1 �_ SSD<<q�-es' Project No <br /> s �Z571o.rJ7� __5 7L Well Designation <br /> Is setup of traffic control devices required YES time hours <br /> Is there standing water in the well box? YES Above TOC Below TOC <br /> Is top of casing cut level'? NO If no,see remarks <br /> Is well cap sealed and locked9 / NO If no,see remarks <br /> Height of well casing nser(in inches) 6 <br /> Well cover type 8"or 12"W 12"EMCO 8"or 12"BK 8"Christy <br /> 12" Christy8"M&D 12"M&D 12"DWP <br /> 12" CNI 36"CNI 12"Porneco Other <br /> General condition of wellhead assembly Excellent Good Fair Poor <br /> Purging Equipment 2" disposable bailer _ Submersible pump <br /> 2" PVC bailer Dedicated bailer <br /> 4" PVC bailer Centrifugal pump <br /> Sampled with Disposable bailer Teflon bailer Disposable Tubing <br /> i <br /> Well Diameter 2" 41) _ 6" 8" <br /> Purge Vol Multiplier 0 16 0 65 1 47 2 61 gal/ft <br /> I Initial Measurement Recharge Measurement <br /> Time `7 'JA Time CaIculated purge 3� <br /> *Depth of well '014. 4 Depth to water Actual purge 3 9 <br /> Depth to water 6 <br /> Start purge �{0 Sampling time <br /> j Time Temperature E CH Turbidity Volume <br /> qa I 7 . 33 <br /> Sample appearance Lock <br /> Equipment replaced (check all that applyp Note condition of replaced item(s) _ <br /> 2" Locking Cap Locl�' "�'� AIIenhead <br /> 4" Locking Cap Lock-Dolphin 44 9/16 Bolt <br /> 6" Locking Cap Pinned Allenhead (DWP) <br /> Oemarks t <br /> Signature <br /> } ,r <br />